2025 ICD-10-CM code M46.0
(Active) Effective Date: N/A Revision Date: N/A Musculoskeletal - Dorsopathies (M40-M54) Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Spinal enthesopathy: Disorder affecting the insertion points of ligaments and tendons into the spine.
No specific modifier rules are provided.
Medical necessity is established based on the presence of symptoms (pain, stiffness, limited range of motion), clinical findings on examination and imaging, and the need for pain relief and improvement in functional capacity.Documentation should clearly demonstrate the presence of enthesopathy and justify the need for treatment.
Diagnosis is based on patient history, physical examination, imaging (X-rays, MRI), and lab tests. Treatment involves managing pain and inflammation with medication (NSAIDs, corticosteroids, TNF blockers), rest, ice, and physical therapy to improve range of motion and flexibility.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Dorsopathies (M40-M54), Spondylopathies (M45-M49)
In simple words: Spinal enthesopathy is a problem where the places where tendons and ligaments connect to your spine become inflamed, causing pain and stiffness. Doctors diagnose it with exams, X-rays, and blood tests. Treatment often involves pain relievers, rest, and physical therapy.
Spinal enthesopathy is a condition characterized by inflammation or degeneration at the entheses (sites where tendons or ligaments attach to bone) in the spine. This can cause pain, tenderness, swelling, warmth, joint effusion, and decreased range of motion.Diagnosis involves patient history, physical examination, imaging (X-rays, MRI), and laboratory tests (antinuclear antibodies, rheumatoid factor, complete blood count, inflammatory markers, uric acid levels, urinalysis). Treatment includes NSAIDs, corticosteroids, TNF blockers, rest, ice, and physical therapy.
Example 1: A 45-year-old presents with chronic lower back pain, stiffness, and limited range of motion, worsened by prolonged sitting. Physical exam reveals tenderness at the sacroiliac joints.Imaging shows enthesopathy at these sites. The patient is diagnosed with spinal enthesopathy associated with ankylosing spondylitis and prescribed NSAIDs and physical therapy., A 60-year-old with a history of rheumatoid arthritis experiences new onset pain and swelling in the upper spine. Imaging reveals spinal enthesopathy. The patient's rheumatologist adjusts their medication regimen to include a TNF blocker and initiates physical therapy to manage the symptoms., A 30-year-old athlete experiences persistent pain in the lower back after intense training.Physical exam and imaging reveal enthesopathy at the lumbar spine.Treatment focuses on rest, ice, NSAIDs, and modification of training regimen to address repetitive strain.
Detailed patient history including onset, duration, location, and character of pain; results of physical examination, imaging studies (X-rays, MRI), and laboratory tests; treatment plan, including medications prescribed and physical therapy regimen; response to treatment.
** Spinal enthesopathy can be associated with various inflammatory and non-inflammatory conditions.Accurate coding requires proper diagnosis and documentation of the underlying cause.
- Payment Status: Active
- Specialties:Rheumatology, Orthopedics, Physical Medicine and Rehabilitation
- Place of Service:Office, Hospital (Inpatient/Outpatient), Clinic